Laser complications lessened by avoiding sales pitches

Key Points

Philadelphia - The only way to avoid laser complications is to avoid performing laser surgery entirely, says Eric Bernstein, M.D., clinical professor, department of dermatology, University of Pennsylvania School of Medicine.

By the same token, he says, "You don't have to treat every patient. Just because you think your laser can help somebody, that doesn't mean they're going to see the benefit and appreciate what you're doing," because some patients possess unrealistic expectations. "Unfortunately, sometimes you have to punt, even though you think it's somebody you could treat effectively."

With all laser or light treatments, Dr. Bernstein says physicians must respect melanin pigment. "Be very cautious treating dark-skinned patients," he says. This means considering longer wavelengths, such as the 1,064 nm Nd:YAG laser for hair removal, and longer wavelengths for Fitzpatrick skin types V and VI, as well as performing test spots in inconspicuous areas before proceeding to larger treatments. If hyperpigmentation occurs after a laser treatment, do not retreat until it resolves, which sometimes will require use of bleaching agents.

Safety first

From a logistical and safety standpoint, Dr. Bernstein says, "I don't believe you should keep laser goggles outside the treatment room door and allow people to open the door and put them on while you're treating. In today's world, there are too many wavelengths" being used therapeutically - and often in the same room.

Multiple-wavelength goggles exist, he says, but at best they only work for three or four wavelengths. There's also the chance that someone could pick up goggles of the wrong wavelength. "Nobody can 'hand you' the wrong glasses, since it's your responsibility to check the wavelength ranges and optical densities written on the glasses and be sure they are for the wavelength being used," he says.

Dr. Bernstein says he locks his treatment-room door during treatments (though not all states allow this). For the sake of anyone outside the room who could be hit with incidental light, "No one should ever be opening a door while someone inside is providing laser treatment," he says.

As for specific treatments, "Hair removal lasers that use long wavelengths and large spot sizes should never be used around the eye," Dr. Bernstein says. Such lasers can penetrate through skin into the eyelid. To avoid this, "I draw a line with white eyeliner pencil parallel to the inferior orbital rim extending toward the ear, and I do not treat above it. Never treat a unibrow with a hair laser. I refer those for electrolysis."